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PATHOPHYSIOLOGICALLY AND CLINICALLY SUBSTANTIATE
CHANGES IN INTERLEUKIN DYNAMICS IN DIABETIC MACRO - AND
MICROANGIOPATHIC WITH PATIENTS
Mominov Alisher Tashkarganovich
Senior lectures of General Surgery No.2, Tashkent Medical Academy, Tashkent
city, Uzbekistan
The purpose of the work.
Determination of the effectiveness of ozone
therapy and its pathomorphological properties with new pharmacological drugs for
the treatment of purulent necrotic process of the foot. By studying the dynamics of
anti-inflammatory cytokine levels: analysis of the need and possibility of
immunoprotection by studying cytokine status in IL-1β, IL-2, IL-4, IL-6, IL-8, IL-
10, TNF-α, INF-γ patients on the development and recurrence of purulent-necrotic
processes of DFS.
Materials and methods.
The concentration of cytokines in the blood plasma
was determined using the StatFax 2100 immunological complex (manufactured by
Cytokin LLC, St. Petersburg) by enzyme immunoassay (IFA). The obtained results
are carried out using descriptive and non-parametric statistical methods on a
personal computer with mathematical processing using Statistica 6.0 software.
Control parameters of the manufacturer's cytokine norms were used - the normative
parameters obtained as a result of testing the donors were obtained from the
manufacturer Cytokin LLC, St. Petersburg, Russian Federation. Plasma collection
and cytokine level testing were performed on day 1 before surgery and on days 3, 5,
7, and 10 after surgery. The study was conducted in three phases and, accordingly,
the patients were divided into 3 research groups: Group I (control group) - blood
serum of patients with purulent-necrotic lesions of diabetes for the study of the
cytokine system; II group (comparison group) - blood serum obtained during the
treatment of patients with purulent-necrotic lesions of diabetes with ozone therapy
and "Reosorbylact" - 200.0 ml (YURIYA-FARM LLC, Ukraine); Group III (main
group) - blood sera obtained during the treatment of patients with purulent-necrotic
lesions of diabetes with ozone therapy and Reomannisol - 200.0 ml (REKA-MED
FARM LLC, Uzbekistan). To determine the imbalance of cytokines, consists of
taking the blood plasma of 60 patients with purulent-necrotic lesions of diabetes and
“JOURNAL OF SCIENCE-INNOVATIVE RESEARCH IN
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determining the amount of cytokines in it. 60 patients were treated at various levels
in the Purulent surgical department of the Yakkasaroy District Medical Association
between 2021 and 2023. The age range of the patients was between 48-60 years.
Neuropathic form of DFS - 25 people (type 1 DM - 2 patients, type 2 DM - 23): 12
were men and 13 women, and neuroischemic form of DFS - 35 patients (all with
type 2 DM): 15 men and consisted of 20 women. Most often, amputations were
performed at the thigh level - 33.3%, heel area - 20%, finger level - 18.3%,
necrotomy - 6.7%, and sequestrectomy - 11.7%. Upper amputations were also
performed as the main option, as a result of the failure of the approach to save vital
organs: at the thigh level - in 33.3% of cases, and at the heel level - in 20%.
Results.
The procedures performed in patients of group III. Operations
performed to save the leg: necroctomies - 42.9%, sequestrectomy - up to 31.3%,
amputations at the level of toes - 42.8%, amputations at the level of the heel - 34.3%.
In addition, the number of high amputations: at the hip level - 28.6%, and at the heel
level - 2.9%. Compared to the second group, the number of upper amputations
decreased from 65.7% to 28.6%. In addition, the antioxidant effect of Reomannisol
manifested in the induction of inflammatory and anti-inflammatory cytokines, was
determined. IL-1β: high level of cytokine up to 64.59±3.3 pg/ml on the first
postoperative day, increased to 95.27±2.2 pg/ml on the fifth day and decreased to 20
± 1.8 pg/ml. IL-1b promotes the proliferation of monocytes, macrophages,
neutrophils, endothelium, smooth muscle cells, fibroblasts, keratinocytes, T- and B-
lymphocytes, along with other cytokines; increases the stimulation of receptors for
IL-2; activates endothelial cells; induces an acute phasic response. IL-2: increases to
1.2±0.3 pg/ml on the first postoperative day, to 1.7±0.13 pg/ml on the third day, and
0 at discharge. After an increase in IL-2, the active implementation of the immune
response and the activation of T cells show. IL-4: fluctuations were noted within
normal limits and an increase was observed in only one case, that is, 76 pg/ml in a
patient with an allergic background, which increased due to the development of
postoperative traumatic dermatitis on the limbs after surgery. Reomannisol may
stimulate the production of this cytokine by mononuclear cells in the peripheral
blood of allergic patients. However, as a result of antioxidant activity, there are
fluctuations in the group of cytokines with pro-inflammatory effects, but only within
normal limits. IL-6: a high level of cytokine up to 228.92±5.1 pg/ml was recorded
on the first postoperative day. Then it gradually returned to normal, and by the time
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of discharge from the hospital, it was back to normal. IL-6 is produced by T-
lymphocytes, monocytes, macrophages, and fibroblasts. Hematopoiesis causes the
differentiation of progenitor cells, stimulates the development and production of
megakaryocytes, promotes the growth and differentiation of platelets, T- and B-
lymphocytes, and stimulates the production. IL-8: peak cytokine levels increased to
181.14 ± 4.1 pg/ml on the first postoperative day, 245.47 ± 5.9 pg/ml on the fifth
day, and 53 ± 1.1 pg/ml at hospital discharge. decreased to ml. As revealed in the
study of the previous two groups, the growth of this cytokine characterizes the
transition of the process to a chronic form. IL-10: An anti-inflammatory cytokine
produced by T-lymphocytes, macrophages, keratinocytes, and B-lymphocytes. It
blocks the functional activity of macrophages and the production of anti-
inflammatory cytokines by monocytes and macrophages. It increases the
proliferation of B-lymphocytes and the secretion of immunoglobulins IgE. However,
IL-10 can stimulate the synthesis of IL-4 in a balanced state. By preventing the
systemic response to the inflammatory process, IL-10 ensures a balanced level of
inflammatory and anti-inflammatory cytokines and controls the immune response,
which has a positive effect on the prevention of purulent-necrotic recurrence. TNF-
α: produced by macrophages, monocytes, keratinocytes, T-lymphocytes, B-
lymphocytes, neutrophils, and endothelial cells. TNF-α has a variety of effects,
occurs due to the modulation of the expression of genes for cell growth factors,
cytokines, transcription factors, cell surface receptors, and acute phase proteins, and
plays an important role in protection against them. The increase of this cytokine on
the third day up to 150.6±5.3 pg/ml after the operation is included in the high activity
and the cytokine itself. INF-γ: on the first day, a high level was recorded to 194±3.4
pg/ml, on the third day it increased to 205.9±6.5 pg/ml and decreased to 5.39±0.3
pg/ml, this indicates its immunomodulatory value and involvement in the regulation
of the anti-inflammatory response.
Conclusion.
In the case of purulent-necrotic processes in DFS, the adequate
introduction of the cytokine system is characterized by the slowing down of the local
process, corresponding to acute inflammation, but increases the tendency of the
process to go into a chronic state. With the recurrence of purulent necrotic
inflammation, there is a synchronization of the process and a secondary immune
deficiency, which does not allow the cytokine system to adequately join the anti-
inflammatory system. Reomannisol allows us to consider it a physiologically active
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compound with clear antioxidant activity. Reomannisol has an antioxidant effect on
the cytokine system, correcting the cytokine balance. It can decrease the function of
pro-inflammatory and anti-inflammatory cytokines, and interferons. Reomannisol is
effective in preventing the recurrence of purulent-necrotic lesions of DFS in
conditions of secondary immunodeficiency, so it is a necessary drug in the main
therapy complex.
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